P - 81356II���IIII ��I II�IIIIIIII�I�I�IIIIII ��II�II MS �1 UoiS SseO BeLRo 3R�CSCst PaPEMNION04 ����
* 0 3 9 2 3 7 1 7* Pnone�sizJSaz-oaoo •---
Home Duplex Apt. Bldg. Other: New Addn
Other:
by this ie�7uest Enter remarks in fhis space antl on the back of the white copy only.
SAVEk'S SWITCH INSTALLATION
ulate Inspection Fee - This Inspecfiwr qequest will not be accepted without fhe covecf /ee:
Other Fee � Service Entrance Size Fee � Circuits/Feeders Fee
Mo6ile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200_Amps Above 100_Amps
Transformer/Generaror MSPECTOH'S USE ONLV TOTAy ` 5@
Sian�OuNine Lta. xfmr. !•�
' 9 ' Final / _�e�v--' I OZ¢ .; � �
Investi ative Fee �_�� �� �L
THIS INSTALLAIION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
OFFICE USE ONLV This request witl 18 rtanihs imm valitlation da�e printed in this box.
392-371�1] ��� 5 �j
JOB NUMBER #55�06000
PLEASE PRINT OR TYPE
Req e Pouoh-ln inspection requiretl? � Yae o Inspection Othar TM1an RougM1-In: Raedy Now � Will Gall
�YOU mus[ oell ihe irASpenfor when reatly) De�e Reatly: 1 1���� 9�'
I, licensed contrector ❑ owner hereby request inspectlon ot ihe a6ove elect(ical work at:
�ot���c��eetsox,o��r�,et�q�E $T NE ��?IDLEY Z�O.`�i�421
Sec�ion No. Township Name or No. Ranoe Na Firs Nn County
ANOKA
Vccupam Phone No.
IRENE KUS'HNIR 571-5286
Povrer Supplier Adtlress
FIS'P MPLS OFFICE
ElecMCal ConVac�or (Compeny Name) ConhaGOr Licariss No_ Master Gc No. (Rant Elsct Only)
MASTER ELEL'TRIC CO. , INt;. CA01192
Mailing Atltlress (Cmtractor or Owner Performing Ins�allation)
12467 BOONE AVE 5.5AVAGE MN. 55373
Phone No.
E8-000�1A-11 fl/95 STATE BOARD COPV � SEE MSTRUCTIONS ON BACK OF YELLOW COPV